What is a glottis and why doesn’t my surgeon want me to close it while working out?

Note: In case you did not notice the countdown clock, my surgery is now 25 days away.

During my meeting with the surgeon this week, we asked about future workouts (i.e. lifting weight) and he told us that I should be able to return to lifting weights, but not to the extent that I close my glottis. We asked for an explanation and he gave us a visual and auditory demonstration (imagine sort of bearing down and grunting). But I decided I wanted to do a bit more research about this. So where and what is this glottis?

The glottis is the opening between the vocal cords at the upper part of the larynx. It is also described as the vocal apparatus of the larynx, consisting of the true vocal cords (vocal folds) and the opening between them.

Okay, so how does weight lifting close the glottis? According to Livestrong.com, “People are often tempted to hold their breath during heavy exertion, which is called a Valsalva maneuver. The Valsalva maneuver involves forcibly exhaling against a closed glottis (entrance to the throat), which increases your intrathoracic pressure (pressure in your chest). This raise in chest pressure can couple with adverse effects that could become life-threatening.”

The Valsalva maneuver causes your blood pressure to rise to extremely high levels.

“According to an article published in Heart Lung, the physiological process that occurs during the Valsalva maneuver starts with a decrease in venous return (the amount of blood coming from the veins to the heart), due to the strain of effort. Next, an increase in both venous and arterial pressures occurs. Because this increased pressure makes it harder for your heart to pump blood, it compensates by increasing its pumping rate and force. Once you resume normal breathing, venous return increases so quickly that the heart does not have time to alter its rate and force of pumping. Thus, it continues pumping hard and fast with a much higher volume of blood, while the arteries remain constricted. Since there is no room for that extra blood in your arteries, the pressure of your arteries elevates to a much higher level than if you were to breathe normally during exertion.”

So what could happen if I did this Valsalva maneuver?

According to Livestrong.com, “The blood pressure response to the Valsalva maneuver is dangerous because it compromises blood flow to important areas of the body, including the brain. Holding your breath during weight-lifting could cause dizziness or even fainting, especially when standing. In addition, according to the University of North Texas Health Science Center, the Valsalva maneuver increases your risk of catastrophic brain injuries. Such injuries include stroke, cerebral hemorrhage, retinal (eye) hemorrhage and retinal detachment.”

How do I avoid doing this?

The most obvious – breathe. Don’t hold your breath during any part of the process. Some sources suggest that breathing in during the eccentric phase and out during the concentric phase may keep blood pressure lower. An example of eccentric versus concentric – in a bicep curl, the movement of the hand and weight toward the shoulder is the concentric movement while lowering the arm is the eccentric movement.

The important message to me is that I can return to lifting weight. For the most part, I was not lifting very heavy (i.e. I could do 10 to 15 reps of the weight I used), so I am not overly concerned about watching the upper limit of my lifts. However, from this point forward I will be much more vigilant about my breathing and will make sure that I am not holding my breath.

(Note #2: remembering to breathe seems to be a trend for me as I mentioned breathing in my pre-surgery to do list)